Provider Demographics
NPI:1518948181
Name:MARTY, GERARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:R
Last Name:MARTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W SALT CREEK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5001
Mailing Address - Country:US
Mailing Address - Phone:847-870-4200
Mailing Address - Fax:847-870-0059
Practice Address - Street 1:3030 W SALT CREEK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5001
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074683207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360746831Medicaid
IL01634499OtherBCBS
ILE80204Medicare UPIN
IL716160Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL0360746831Medicaid
ILL15895Medicare PIN